Vaida Averjanovaitė

Background and Objectives: Pulmonary embolism (PE) is a potentially life-threatening disease. Although anticoagulant therapy reduces the risk of recurrent PE, it increases the risk of bleeding complications. Therefore, decisions regarding treatment duration are made individually, balancing recurrent venous thromboembolism (VTE) and bleeding risk. However, the optimal duration of anticoagulant therapy after acute PE remains challenging in clinical practice. The aim of this study was to evaluate bleeding rates during anticoagulant therapy and identify possible bleeding risk factors. Materials and Methods: A prospective study was conducted at a tertiary pulmonology center within a university hospital. A total of 201 consecutive patients (50.2% male) after a first episode of acute PE were included. Bleeding complications during anticoagulant therapy were recorded at follow-up visits and classified as major and minor. Potential risk factors associated with increased bleeding risk during anticoagulant therapy were analyzed. Results: During follow-up, 35 patients (17.4%) experienced bleeding complications, including 5 (2.5%) major and 30 (14.9%) minor bleeding events. Recurrent bleeding occurred in 6 patients (17.1%). The median time to first bleeding event was 3 months (IQR 1–7.5). Patients receiving extended anticoagulation beyond 6 months experienced more frequent bleeding events, predominantly non-major bleeding; however, bleeding incidence per patient-year did not differ significantly according to treatment duration (IRR 1.26, 95% CI 0.63–2.49). Other factors associated with increased bleeding risk included prior bleeding history, PE with no identifiable provoking factor, elevated B-type natriuretic peptide (BNP) levels and high early PE mortality risk at hospitalization. Conclusions: Bleeding during anticoagulant therapy after PE was frequent, but mostly non-major. More bleeding events (non-major) were observed among patients receiving longer anticoagulation, although this difference was attenuated after adjustment for anticoagulation exposure time. Prior bleeding, unprovoked PE, and markers of more severe PE were associated with increased bleeding risk. Findings suggest that prolonged anticoagulation is safe when clinically indicated, although regular reassessment of bleeding risk remains important.

Pulmonary hypertension (PH) is a frequent complication of fibrotic interstitial lung diseases (ILDs), but its detection remains challenging due to overlapping clinical features. We aimed to evaluate the discriminatory power of physiological and exercise‐based markers that differentiate right heart catheterization (RHC)—confirmed PH from low‐probability ILD cases. In this prospective observational study of 59 patients with ILD, we evaluated pulmonary function tests (PFTs), cardiopulmonary exercise testing (CPET), and the 6‐min walk test (6MWT). Patients deemed at high probability for clinically relevant PH following a multidisciplinary assessment were referred for RHC. Receiver operating characteristic (ROC) analysis was used to compare RHC‐confirmed PH cases ( n = 18) with a clinically low‐probability ILD cohort ( n = 19). Patients with RHC‐confirmed PH had significantly lower diffusing capacity for carbon monoxide (DLCO) (43.44 ± 13.73% vs. 59.11 ± 13.50%, p = 0.002) and higher ventilatory inefficiency, as measured by the VE/VCO ₂ slope (47.00 ± 7.90 vs. 40.71 ± 8.48, p = 0.035). DLCO showed moderate discriminatory performance (AUC 0.799; optimal cut‐off 50.5% predicted; sensitivity 72%; specificity 72%), whereas VE/VCO ₂ slope showed fair discrimination (AUC 0.711; cut‐off ≈ 41.5; sensitivity 75%; specificity 59%). Although 6MWT distance did not differentiate the groups, post‐exercise oxygen desaturation and heart rate were significant indicators. In fibrotic ILD, gas exchange and ventilatory inefficiency parameters—specifically DLCO and VE/VCO ₂ slope—effectively discriminate RHC‐confirmed PH from clinically low‐probability cases. These markers offer a practical screening approach to identify patients who should be prioritized for further PH testing.

Background and Objectives. COVID-19 infection has a significant burden on global morbidity and mortality, especially in elderly people and in patients with chronic respiratory and cardiovascular diseases, such as pulmonary hypertension (PH). We aimed to evaluate the impact of COVID-19 infection on patients diagnosed with severe chronic PH. Materials and Methods. A single-center prospective cohort study was performed. Patients were enrolled from 1 November 2020 to 31 December 2022. Follow-up was until 31 December 2023. Data were collected on PH diagnosis, clinical presentation, outcomes, brain natriuretic peptide (BNP) levels, pulmonary function test with lung diffusion capacity for carbon monoxide (DLCO), and computed tomography pulmonary angiography (CTPA) analysis. Results. During the 26 months of our study, 51 PH patients were diagnosed with COVID-19 infection. The majority, 44 (86.3%) of all COVID-19 infected patients, were treated on an outpatient basis, and 7 (13.7%) required hospitalization. During the follow-up period, 8 (15.7%) patients died: 4 (7.8%) due to complications of COVID-19 infection, and the other 4 (7.8%) died in the later stages of the follow-up period after recovery from acute COVID-19 infection. Therefore, the in-hospital mortality in our study was 43% (n = 3). As mentioned above, the overall mortality was 7.8% (n = 4). Higher BNP levels in the third month after COVID-19 were associated with higher mortality rates (p = 0.028). Lung function, including DLCO, did not significantly worsen with COVID-19. In our study, 24 patients (47.1%) were referred for a follow-up CTPA scan and one of them developed typical fibrotic lung changes after COVID-19. Conclusions. The incidence of COVID-19 infection in patients diagnosed with PH was 34%. In our patients with severe chronic PH, the overall mortality rate due to COVID-19 infection was low. Pulmonary fibrosis was a rare complication in our cohort. COVID-19 infection in severe PH may increase the risk of worsening chronic heart failure.

This article provides a comprehensive overview of the latest literature on the diagnostics and treatment of pulmonary hypertension (PH) associated with interstitial lung disease (ILD). Heightened suspicion for PH arises when the advancement of dyspnoea in ILD patients diverges from the expected pattern of decline in pulmonary function parameters. The complexity of PH associated with ILD (PH-ILD) diagnostics is emphasized by the limitations of transthoracic echocardiography in the ILD population, necessitating the exploration of alternative diagnostic approaches. Cardiac magnetic resonance imaging (MRI) emerges as a promising tool, offering insights into hemodynamic parameters and providing valuable prognostic information. The potential of biomarkers, alongside pulmonary function and cardiopulmonary exercise tests, is explored for enhanced diagnostic and prognostic precision. While specific treatments for PH-ILD remain limited, recent studies on inhaled treprostinil provide new hope for improved patient outcomes.